Health, Wealth, and Cooperatives: A Conversation with Jen Horonjeff
This interview series is a collaboration between IDEO, Robert Wood Johnson Foundation, and Building H to imagine how we might design health into everyday life.
Health is much more than a diagnosis, it represents an individual’s whole self. If we see health not as the absence of disease but rather the presence of vitality, then designing for health means designing for people’s diverse experiences, histories, and everyday lives. In this interview, I speak with Jen Horonjeff, Founder and CEO of Savvy Cooperative, to learn about how the cooperative business model gives patients voice and ownership, and in doing so, enables communities to build equity in their health.
From Extracted Value to Shared Ownership
Joanne: Running a cooperative startup in the health space is not the norm; why did you choose a shared-ownership structure and how do you see that as the way to make an impact?
Jen: There’s a personal reason and a business reason for why we do it.
The personal reason is that I consider myself a patient. I’ve grown up with several different chronic autoimmune conditions. Notably, I was diagnosed with juvenile idiopathic arthritis when I was an infant, and then I got a whole laundry list of other conditions added along the way. I had a brain tumor removed seven years ago. Being a patient has informed my desire to go into healthcare professionally.
The business aspect of it is that I’d been a patient for so long, being asked to share my insights for free while a company gets those insights and profits, and it made me uncomfortable to realize that what we were initially building [at Savvy] was a for-profit company. I did not want to be one of the people who are profiting off of my peers, the ones sharing their expertise. After some research, I realized that our company can be structured as a cooperative, where we share ownership with individual patients.
The co-op model gives patients a voice, and it makes sure that they’re equitably valued based on their contributions to the co-op.
Joanne: Do you think the changes caused by the pandemic might make it easier for more co-ops or more alternative business models to flourish?
Jen: I absolutely think that businesses will have to explore other models. The legacy of co-ops is that they’re more resilient. They are shown to continue on and prosper even in economic downturns. People think if they don’t keep growing, then they just go out of business, but no, there are other options. I know there’s a lot of interest in alternative financing models because the regular venture capital model isn’t necessarily working well right now. I’m hoping that Savvy may help inspire other businesses that aren’t right for traditional venture capitals.
Joanne: What are some of the biggest barriers to building genuinely patient-centered businesses?
Jen: I think a lot of people think they’re not allowed to talk to patients, which is not true. It’s also hard to find diverse patients — that’s really what Savvy set out to solve. Our co-op model is very effective at doing that because our members activate their own networks to find diverse individuals.
I also think many people think talking to people — the basis of qualitative research — is just cute, fluffy stuff. They don’t understand that this is a smart business decision. If you actually understand the needs, experiences, and use cases of your product or service, you’re going to find a better market fit, and you’re going to get to market faster.
Too often companies design a solution in a vacuum and think it will just integrate seamlessly, and that’s the problem. One of my least favorite terms in healthcare is “noncompliance.”
We blame the patient for not following their treatment plan, when the treatment plan was never designed with all of their unique needs in the first place.
Joanne: If one is trying to design something to benefit a group of patients, when is the most effective time to start gaining these insights and initiating the conversation? Is it iterative?
Jen: The answer is always yesterday. You can never do this soon enough. And you just said it: it should be iterative. It can feel like such an undertaking, but just start somewhere and then build upon it, learn, and continue to build.
Patient insights are valuable no matter where you are in your development, it just might look a little different. We want to remind people that patients are the end users of healthcare, so let’s make sure that we’re actually talking to them throughout any sort of development.
Joanne: As you built Savvy, you’ve designed different ways for the co-op members to interact with others who might be learning from and getting insights from them. What are some examples of interactions that happen?
Jen: I think the core offering is connecting individual patients or consumers directly with companies to interact and provide feedback. After an engagement, we always ask both the client and the patients how it went, and we share it back. A company might say, “Thank you for participating in these interviews. Your thoughts helped inform this new program that we’re rolling out.” And those individuals go, “I was part of that!” It helps ascribe purpose to the horrible experiences that they may have gone through, and they then can share that back with their communities with pride.
As a co-op, there’s nothing that makes me happier than when I see co-op members using language like “we,” “us” and “ours” on things like social media. It shows that they feel strongly that they have ownership in this organization.
That also makes it an authentic and easy way for somebody else to join.
From Disease Silos to Holistic Care
Joanne: You mentioned that people with chronic illnesses often get labeled as their illness. How do you navigate that at Savvy?
Jen: Savvy is deliberately disease-agnostic. I don’t believe in labeling a person as their diagnosis when so many of us live with co-morbidities. When we offered opportunities to discuss mental health, we were flooded by people who wanted to contribute because these individuals have oftentimes been labeled as their physical chronic condition, whether that be arthritis, MS, or cancer.
Joanne: In the context of the pandemic, are you seeing any changes that might enable more holistic care?
Jen: The first thing that comes to mind is the fact that so many people’s health insurance is tied to their employer. If we’re losing jobs, we need to rethink how we can make sure people have access to quality healthcare. What’s happening now with the pandemic is almost level-setting: there’s so much that we don’t know. I hope that we can just get a little bit comfortable with that and understand that we need to start to rebuild things from the ground up, because that’s a great starting-off point to have more community-driven research to understand what is important to those individuals.
Joanne: What is the connective tissue between healthcare and other parts of one person’s life, so that everything else can be created to support a person’s health in a holistic way?
In reality, these people are struggling with so many other things, and rarely has anybody ever asked them about their mental health.
We also have opportunities to discuss fertility, nutrition, exercise, and physical activity, so there are multiple ways that people can contribute. What’s really empowering is that these people are finally asked about something outside of just their clinical diagnosis.
Look at what’s happening now with the pandemic: everybody’s isolating, but there’s going to be different experiences and constraints for people who have things like a chronic health condition. We need to be cognizant of that because the way that they interact with the world is going to be different. A person’s health condition ties into every other aspect of their life.
